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How Denver Voters Decided to Help Address a Major Health Equity Gap

State Rep. Leslie Herod (D-Denver) was a driving force behind an ordinance passed by Denver voters to increase funding for behavioral health services.

Photo provided by Leslie Herod

By Michael Booth

Denver’s mental health providers and clients briefly celebrated a major electoral victory for more funding last month, and then quickly rolled up their sleeves to implement the new law, with the first millions in grants not likely to be delivered until late 2019.

The Caring 4 Denver effort—Initiated Ordinance 301 on the 2018 Denver ballot—is a sales tax increase estimated to deliver about $45 million a year in new funds for mental and behavioral health services throughout the city. Built into the ordinance is the mandate that the money create new programs and services, and that existing mental health spending will not be cut.

Caring 4 Denver won with a resounding 70 percent voter approval, making it one of the most popular election issues in a year when other local and state tax initiatives experienced tight votes or outright rejection. The measure will add one-quarter of a cent to the price of most goods and services in Denver, or 25 cents to a $100 purchase.

“I’m ecstatic that Denver voters chose overwhelmingly to support Caring 4 Denver and better services for their community,” said state Rep. Leslie Herod (D-Denver), who was a prime force behind creating the ordinance and often the public face of the campaign effort. “It’s particularly good that it came with lots of competing priorities on the ballot, and Caring 4 Denver was the number one priority. People want to help each other, and that’s a very good thing.”

The law adds a few restrictions on some of the money: In the first two years, 20 percent of the new funds will be set aside to create a new form of mental health facility in Denver aimed at people in the criminal justice system who should not be in jail. That set-aside will also pay for expansions of co-responder programs, where mental health professionals ride along with police to divert arrests of people who need counseling or substance abuse services; and for training of first responders to recognize behavioral health issues.

In the following years, 10 percent of the tax will be set aside to run the new facility. No more than 5 percent of the revenue can be used for administrative expenses.

Herod said the need for an alternative facility is one of the most pressing in the city; she said she and other lawmakers hear from every jailer and police officer that cells have become all-too-easy holding places for people who need behavioral help, not prosecution.

One story that struck Herod on the campaign trail was at the Gilliam youth detention center in Denver’s Whittier neighborhood, where a staffer told her that “80 percent of the young people coming in have a mental health or substance abuse issue; and 100 percent leave with them.”

Herod and other supporters say the new funding is aimed at narrowing an enormous health equity gap in behavioral services.

“Compared with the majority population, members of racial and ethnic minority groups in the U.S. are less likely to have access to mental health services, less likely to use community mental health services, more likely to use inpatient hospitalization and emergency rooms, and more likely to receive lower quality care,” according to the Minority Health and Mental Health Disparities Program of the National Institute of Mental Health.

Even in public schools, Herod said, some Denver neighborhoods are able to support funding for activities or behavioral services that other schools can’t afford.

“Those who can least afford it are the ones who are hurt the most,” she said.

Disparities can be found within almost any group where civic leaders have struggled to deliver transformative levels of social services. For example, a 2017 federal census of the homeless—a group with high levels of need for mental-health services—estimated that 40 percent of the homeless population nationwide is African-American, far greater than their share of the overall population at 12 percent.

Under the new ordinance, which still requires implementing language to be passed by Denver City Council, a new nonprofit will be established to receive and disburse the tax dollars. The nonprofit’s board will include six appointments by the mayor, two by the district attorney and five by city council. (Some city leaders have raised questions about turning over public tax money to a new nonprofit entity, calling it a form of privatization of essential services.)

Grants could be made by the last quarter of 2019, Herod said.

Denver’s social services community hailed the overwhelming vote for the new funding, and said they are eager to contribute ideas to the structure of the new nonprofit as well as submit applications for the money pool.

“It’s $45 million dollars that we didn’t have before to address need in our city,” said Jessica Vasquez, vice president of quality and operations for the Colorado Community Health Network. CCHN represents 20 community health clinic networks across the state, including Denver’s Clinica Tepeyac, Denver Health, Inner City Health Center and the Colorado Coalition for the Homeless Stout Street Clinic.

“Community health clinics in Denver see a large number of patients who are dealing with substance use disorders and mental health. Having access to ongoing funds would allow clinics to develop sustainable programs to impact patients,” Vasquez said. Specific needs for expanded funding include housing with mental health supports, and workforce development for patient navigators and other behavioral health staff.

Advocates for the homeless said they hope the new money can provide sustainable services for the city’s growing stock of community-supported housing.

“Given that Denver just doubled its affordable housing fund, this is a great opportunity to complement those funds with full wraparound services for those with substance abuse disorders and mental health issues,” said Cathy Alderman, vice president of communications and public policy for the Colorado Coalition for the Homeless. “We’re thankful to Denver voters for recognizing this need and investing in it; it’s so critical to make sure people can be stably housed.”